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The World Bank reaffirms its long-term commitment to HIV & AIDS in Africa

At the beginning of last month, from June 3rd to June 7th, Uganda hosted the second global HIV & AIDS Implementers Meeting at the Imperial Royale Hotel in Kampala. The five-day meeting was held under the theme, ‘Scaling Up Through Partnerships: Overcoming Obstacles to Implementation’, and was co-sponsored by the US Presidents Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Children’s Fund (UNICEF), the World Bank, the World Health Organisation (WHO) and the Global Network for People Living with HIV/AIDS (GNP+). The meeting attracted over 1,700 participants from more than 70 countries around the world.

The primary objectives of the meeting were to widely disseminate the lessons learned over the past year, focussing specifically on: the scaling up of prevention, treatment and care programmes; the building of local capacity; quality; and improving coordination among partners. The meeting also aimed to have a direct impact on HIV & AIDS programme implementation over the next year, through encouraging open dialogue about the future directions of HIV & AIDS programmes, best practices, and the identification of critical barriers. Prior to the meeting, Jimmy Kolker, chief of the HIV section at UNICEF, summed up the objectives of the meeting, stating that, "Coming together to share best practices will move us closer to an AIDS-free generation. Kampala will reaffirm the priority that the global community must continue to give to the fight against AIDS".



The World Bank reaffirms its long-term commitment to HIV & AIDS in Africa

Last month, on the 14th of May, the World Bank released its latest strategy document, outlining its plan for tackling HIV & AIDS in Africa over the next five years. The document is entitled “The World Bank’s Commitment to HIV/AIDS in Africa: Our Agenda for Action, 2007–2011” (2), and will serve as a guideline for the Bank in their efforts to combat the HIV & AIDS epidemic in Africa. Prepared primarily for the World Bank’s Board of Directors, senior management, and staff, the 146-page report not only discusses the Bank’s “Agenda for Action (AFA)”, but also includes a comprehensive summary of the Bank’s response to the epidemic thus far, lessons learned, and discusses the “significant emerging challenges to the effective control of the epidemic”. The report therefore also provides valuable information for a wide variety of organisations and institutions working in the field of HIV & AIDS, and not simply the Bank itself. According to Peter Piot, Executive Director of UNAIDS, the AFA reaffirms the World Bank’s long-term commitment to assist African countries in their fight against HIV & AIDS.

THE FIRST GLOBAL RESPONSE

It was almost a decade ago, in 1999, when the World Bank launched what was to be the very first major global response to HIV & AIDS. Since then, in attempts to combat the epidemic, the Bank has provided over US$ 1.5 billion to more than 30 countries in Sub-Saharan Africa. In an initial first stage of its commitment to fighting the disease, back in 2000, the Executive Directors of World Bank approved a US$ 500 million commitment with the Multi-Country HIV/AIDS Program (MAP) for Africa. An AIDS Campaign Team for Africa (ACTafrica) was introduced to implement the strategy, and also to provide operational support. Two years later, in February 2002, the World Bank Board approved a further US$ 500 million, improving their reach, and leading to the support of a number of regional programs and second-generation projects in Sub-Saharan Africa.



Family planning integration: A proven, but highly under-utilised prevention strategy

According to an Issue Brief, released by USAID in 2006 (2), family planning in the era of HIV & AIDS is more important than ever. The brief discusses why family planning is so essential in the context of HIV & AIDS, especially in the developing world. Half a million women and 11 million children die each year from pregnancy-related complications, and family planning integration could potentially prevent 25% of these deaths. Family planning programmes, if implemented effectively, can play an important role in assisting HIV prevention goals, and in the same vein, HIV programmes can assist in broadening access to family planning services.

Another briefing paper, released by USAID last year (2), documents “Family planning choices for women with HIV”, and states that family planning is also the key strategy to prevent or reduce mother-to-child transmission (PMTCT) of the HI-virus. Family planning integration also provides an important entry point for a wide range of other services, and allows more contact opportunities with a client, because more services are offered. In addition, service providers are cross-trained in a variety of issues, which greatly assists in efficient information dissemination. Family planning can also often encourage the involvement of men, and so such integration can potentially increase the number of men who have contact with HIV & AIDS services. From a more sociological viewpoint, family planning can also play a “pivotal role in population growth, poverty reduction and human development” (3).



Nigerian leaders setting an example for the continent - April: 2008

Two months ago, the HIV & AIDS February newsletter stressed the importance of leadership in the fight against HIV & AIDS. The article questioned how South Africa, a country that receives the largest bulk of international assistance, and devotes more resources to the epidemic than any other country in Africa, remains the country most severely affected. It went on to suggest a relative absence of strong leadership in South Africa’s attempts to address the epidemic, as the main reason for the ineffectiveness of such attempts. This can be illustrated in a country such as Nigeria, who, for instance, despite having the second largest number of HIV infections in Africa (after South Africa), has an HIV prevalence rate of just under 4% (2).

Last year, Nigeria received the third highest amount of funding from the Presidents Emergency Plan for AIDS Relief (PEPFAR), behind South Africa and Kenya (3). As was discussed in the February 2008 however, generous funding does not necessarily lead to successful strategies, as strong and effective leadership is essential. Nigeria has proven this point, utilising the funding that has been made available to its full potential, with good leadership and commitment. In this month’s newsletter, Nigerian leaders are highlighted as role models for the rest of Africa, with respect to their pro-active stance on addressing the issue of HIV & AIDS.



Interventions are plentiful…but are they being adequately assessed, and are the lessons that are learnt being distributed? - March: 2008

The month of February has seen the launch and progress of a number of HIV & AIDS related intervention programs in Africa. In Namibia this month, a meeting was held, involving the hosts, Kenya, and Tanzania, focussing on HIV prevention in care and treatment settings. The aim of the meeting was to use the increase in HIV treatment availability to promote the implementation of HIV related interventions, specifically aimed at prevention. In Uganda this month, the World Bank approved the launch of a new US$ 15 million programme to address HIV & AIDS challenges in the Horn of Africa. Whilst in Botswana, researchers from the University of Botswana and the University of Pennsylvania have been granted with funds for a five year project to develop research capacity to investigate issues related to adolescents. These are just a hand-full of HIV related interventions that have been initiated this month across the continent, and interventions such as these will continue to receive new funding, develop new ideas and make much progress in the struggle to overcome the effects of the HIV & AIDS epidemic. While the implementation of such interventions is critical in this fight, one incredibly important aspect in addressing any issue has been too often overlooked. This is the adequate assessment of such interventions, and the write-up and distribution of results.



Funding is necessary, but leadership is essential - February: 2008

2008 has begun in a similar fashion to how last year concluded, with South Africa being the focus of much attention with regards to HIV & AIDS. In 2007, South Africa was found to have overtaken India as the country with the largest number of HIV & AIDS cases. This news raised many eyebrows around the globe, with South Africa continuing to devote more resources to the epidemic than any other country in Africa, yet seemingly being unable to effectively address the many issues surrounding the epidemic. South Africa also receives the largest bulk of International assistance, including funding from the US Presidents Emergency Plan for AIDS Relief (PEPFAR). In January 2008, Mark Dybul, the US global AIDS co-ordinator, stated that the US would be providing South Africa with just under US$ 600 million (ZAR 4.3 billion) over the next year, in support of the country’s various HIV & AIDS programmes. According to Eric Bost, US Ambassador to South Africa, PEPFAR is already involved with funding for over 600 HIV and AIDS related programmes in South Africa. With an increase of US$ 190 million (ZAR 1.4 billion) over the 2007 amount received, PEPFAR is set to contribute slightly more than US$ 600 million (ZAR 4.6 billion) during 2008. Interestingly, this increase is double that of the South African Government, who have budgeted just over US$ 700 million (ZAR 5.3 billion) for the next financial year.



Business and Policy Annual Review: A year of much progress - December: 2007

Another year passes by in the fight against the HIV & AIDS epidemic, and it is becoming ever more important to look back and reflect on the progress, and also the shortcomings of efforts in combating the African continents most terrifying scourge. Africa’s endeavour to stabilise the effects of the epidemic, and international efforts to assist the continent in this regard, have been the focus of much debate and discussion over the past several years, and while there have been a handful of drawbacks and failures, 2007 has been a year full of positive strides and much success. While this newsletter focuses its attention primarily on the political and business related progress in Africa’s fight against the epidemic, it is important to remember that this is not where it ends, or in fact even begins. Community efforts are often neglected; breakthroughs in research are often overlooked, and issues such as violence, stigmatisation and the psychological impact of the virus are often ignored. This said, however, the aim of this newsletter is to review the past years major successes, from a business and policy perspective, in the African continents attempts to address the issue of “HIV & AIDS in Africa”. International funding of HIV & AIDS initiatives are obviously an extremely important step in stemming the tide of the epidemic in Africa, and this year has seen numerous positive strides in upgrading such attempts. The United States Senate approved a Bill that will see the US foreign aid budget rise to US$ 34 billion. US$ 590 million will go towards the “Global Fund to fight AIDS, Tuberculosis and Malaria”, whilst over US$ 5 billion will go towards combating HIV & AIDS worldwide. In May, United States President, George W. Bush announced an increase of funding under the US President’s Emergency Plan for Aids Relief (PEPFAR) to US$ 30 billion in an address at the Rose Garden, in Washington DC. Bush stated that the increased funding is intended to support treatment for nearly 2.5 million people, to prevent more than 12 million new infections, and to support care for 12 million people, including more than 5 million orphans and vulnerable children. Although this funding increase will have a significantly positive impact on Africa, it must be remembered that there is still much needed to be done, both on the ground, and in the political arena.



A missing link in the fight against HIV & AIDS in Africa


The work and research done in Africa to stem the tide of the HIV & AIDS epidemic have, in the past, largely been focused on prevention and medical treatment, but seem to have neglected a rather important aspect, namely the provision of psychological and sociological support for those infected with the virus. While it is incredibly important to prioritise the prevention and treatment of HIV & AIDS, it is just as important to provide effective support for those who are infected. There seems to have been a huge gap in the strategies used to tackle the epidemic in Africa. Non-infected individuals have been targeted with various prevention and awareness campaigns and HIV infected individuals who have developed AIDS can now access treatment in most countries across the continent. However, people that lie in between these two groups, namely those who are infected with HIV, but not yet in need, or not yet in a position where they are able to access treatment, have largely been forgotten. In fact the provision of psychosocial support for people living with HIV has been largely neglected in general. This month has seen both South Africa and Botswana taking positive strides in attempts to close this gap. The Positive Living Helper Cells Support Group (PLHCSG), in Selebi-Phikwe, Botswana, has implemented a buddy programme, which involves pairing two people living with HIV as “buddies” so that they may support each other on issues related to HIV & AIDS. This is a six month pilot project and is aimed at increasing psychological support for and among people living with HIV & AIDS. In South Africa, Mothers2Mothers, one of South Africa’s success stories in attempts to support people living with HIV, have launched a hotline (0800-MOTHERS) this month, which will allow HIV-positive expectant and new mothers to access information and support regarding the prevention of mother-to-child transmission (PMTCT) programme. The hotline will be staffed by HIV-positive women who have successfully given birth to HIV-negative babies through the PMTCT process. Strategies such as these can have a huge, multifaceted impact, not only on the lives of the individuals that receive the much needed support, but on the overall progress made in stemming the tide of the rampant epidemic.